Excludes2

  • symptoms and signs constituting part of a pattern of mental disorder (F01-F99)
  1. R40 Somnolence, stupor and coma

    Excludes1

    • neonatal coma (P91.5)
    • somnolence, stupor and coma in diabetes (E08-E13)
    • somnolence, stupor and coma in hepatic failure (K72.-)
    • somnolence, stupor and coma in hypoglycemia (nondiabetic) (E15)
    1. R40.0 Somnolence

      Inclusion term(s):

      • Drowsiness
    2. R40.1 Stupor

      Inclusion term(s):

      • Catatonic stupor
      • Semicoma
    3. R40.2 Coma

      Note: One code from each subcategory, R40.21-R40.23, is required to complete the coma scale

      1. R40.20 Unspecified coma

        Inclusion term(s):

        • Coma NOS
        • Unconsciousness NOS
      2. R40.21 Coma scale, eyes open

      3. R40.22 Coma scale, best verbal response

        • R40.221 Coma scale, best verbal response, none

          Inclusion term(s):

          • Coma scale verbal score of 1
        • R40.222 Coma scale, best verbal response, incomprehensible words

          Inclusion term(s):

          • Coma scale verbal score of 2
          • Incomprehensible sounds (2-5 years of age)
          • Moans/grunts to pain; restless (<2 years old)
        • R40.223 Coma scale, best verbal response, inappropriate words

          Inclusion term(s):

          • Coma scale verbal score of 3
          • Inappropriate crying or screaming (< 2 years of age)
          • Screaming (2-5 years of age)
        • R40.224 Coma scale, best verbal response, confused conversation

          Inclusion term(s):

          • Coma scale verbal score of 4
          • Inappropriate words (2-5 years of age)
          • Irritable cries (< 2 years of age)
        • R40.225 Coma scale, best verbal response, oriented

          Inclusion term(s):

          • Coma scale verbal score of 5
          • Cooing or babbling or crying appropriately (< 2 years of age)
          • Uses appropriate words (2- 5 years of age)
      4. R40.23 Coma scale, best motor response

        • R40.231 Coma scale, best motor response, none

          Inclusion term(s):

          • Coma scale motor score of 1
        • R40.232 Coma scale, best motor response, extension

          Inclusion term(s):

          • Abnormal extensor posturing to pain or noxious stimuli (< 2 years of age)
          • Coma scale motor score of 2
          • Extensor posturing to pain or noxious stimuli (2-5 years of age)
        • R40.233 Coma scale, best motor response, abnormal flexion

          Inclusion term(s):

          • Abnormal flexure posturing to pain or noxious stimuli (2-5 years of age)
          • Coma scale motor score of 3
          • Flexion/decorticate posturing (< 2 years of age)
        • R40.234 Coma scale, best motor response, flexion withdrawal

          Inclusion term(s):

          • Coma scale motor score of 4
          • Withdraws from pain or noxious stimuli (2-5 years of age)
        • R40.235 Coma scale, best motor response, localizes pain

          Inclusion term(s):

          • Coma scale motor score of 5
          • Localizes pain (2-5 years of age)
          • Withdraws to touch (< 2 years of age)
        • R40.236 Coma scale, best motor response, obeys commands

          Inclusion term(s):

          • Coma scale motor score of 6
          • Normal or spontaneous movement (< 2 years of age)
          • Obeys commands (2-5 years of age)
      5. R40.24 Glasgow coma scale, total score

        Note: Assign a code from subcategory R40.24, when only the total coma score is documented

        • R40.241 Glasgow coma scale score 13-15
        • R40.242 Glasgow coma scale score 9-12
        • R40.243 Glasgow coma scale score 3-8
        • R40.244 Other coma, without documented Glasgow coma scale score, or with partial score reported
    4. R40.3 Persistent vegetative state

    5. R40.4 Transient alteration of awareness

Abbreviations used here:

NEC Not elsewhere classifiable
This abbreviation in the Tabular List represents “other specified”. When a specific code is not available for a condition, the Tabular List includes an NEC entry under a code to identify the code as the “other specified” code.

NOS Not otherwise specified
This abbreviation is the equivalent of unspecified.